The Centers for Medicare & Medicaid Services (CMS) has issued a long-awaited final coverage determination that will immediately provide Medicare coverage for low-dose CT lung cancer screening for high-risk beneficiaries.
“This is an important new Medicare preventive benefit since lung cancer is the third most common cancer and the leading cause of cancer deaths in the United States,” said Patrick Conway, MD, chief medical officer and deputy administrator for innovation and quality for CMS.
Medicare beneficiaries will be covered for one low-dose CT screening exam per year as long as they meet the following criteria:
- Age 55-77;
- Current smoker or quit within the last 15 years;
- Smoking history of at least 30 pack years (average of one pack per day for 30 years); and
- Received written order from a physician or qualified non-physician practitioner that meets certain requirements.
Coverage will include a visit for smoking cessation counseling and shared decision-making discussions on the benefits and risks of screening. Facilities performing the CT scans also will be required to submit data on initial screening findings, follow-up and ultimate outcomes to an approved registry.
Many with private insurance were covered for low-dose CT screening without co-payments, thanks to the U.S. Preventative Services Task Force (USPSTF) awarding it a “B” grade and the Affordable Care Act mandating such highly rated procedures be considered an Essential Health Benefit. However, the same rules did not apply to Medicare, making CMS’ announcement the first time that Medicare has covered lung cancer screening.
A number of imaging and cancer associations issued celebratory statements following CMS’ announcement.
“Medicare coverage of CT lung cancer screening will help screening programs nationwide save lives,” said Ella Kazerooni, MD, FACR, chair of the American College of Radiology Lung Cancer Screening Committee and American College of Radiology Thoracic Imaging Panel.
“Medicare got this right,” said Laurie Fenton Ambrose, president and chief executive officer of the Lung Cancer Alliance. “Screening programs can also help lower smoking rates. The process may even lead to better understanding of addiction as well as lung cancer in those who have never smoked.”
Lung cancer is the leading cause of cancer death for both men and women in the U.S., with a five-year survival of less than 20 percent. The USPSTF estimated that if all those at high risk for the disease were screened, there would be a 14 percent reduction in lung cancer deaths nationwide.